Description of the Model

In describing the model, we will present a combination of outlines, powerpoints, and tables that explains the theory, concepts, and application to nursing.  
Dorothea Orem and Theory in the Making...

 
 Overview of Orem's Self-Care Deficit Theory of Nursing
 
What is the key "problem" or focus of the model/framework?
 
Purpose:
 
According to Polit & Henderson, each individual has the ability to perform self-care, and are responsible for their health and the health of their dependents. Self-care is "the practice of activities that individuals initiate and perform on their own behalf in  maintaining life, health, and well-being" (as cited in Cardinal Stritch University Library, 2011).
 
Orem's initial definition of nursing's concern included "man's need for self-care action and the provision and management of it on a continuous basis in order to sustain life and health, recover from disease or injury, and cope with their effects" (Orem, 1959, p. 3).
 
More simply stated, her definition of nursing's goal was "overcoming human  limitations" (Orem, 1959, p. 4)
 
Orem's general theory of self-care deficit nursing states that a self-care demand exists when the patient of family members are not able to provide care for him/herself and those self-care demands can be met by the nurse (Masters, 2011).
 
According to Sitzman & Eichelberger (2011), "Orem's Self-Care Model describes a structure wherein the nurse assists the client, where needed, to maintain an adequate level of self-care. The degree of nursing care and intervention depends on the degree to which the client is able (or unable) to meet self-care needs (p. 96)."
 
Orem's theory is made up of 3 related theories:
1. Theory of Self-Care
2. Theory of Self-Care Deficit
3. Theory of Nursing Systems
 
According to Orem, "the three-part theory focuses not on individuals, but on persons in relations. Each of the three theories has as its focus a specific dimension of the person: the theory of self-care focuses on the self, the I; the theory of self-care deficit focuses on you and me; and the theory of nursing system focuses on we, persons in community" (1990, p. 49).
 
 
Theory of Self-Care Deficit and Theory of Nursing Systems are both on the same powerpoint below.
 
 
 
How are the three theories related?
The theory of self care delineates the demands of self-care requisites that an individual needs to meet in order to stay healthy or get better from illness. When a person cannot meet these  self-care demands, or when self-care requisites exceeds self-care capabilites, nursing is needed. Nurses can help patients meet their self-care needs by utilizing the 5 methods in the Theory of Self Care Deficit. However, the nurse must properly assess the level of self-care a patient requires so that the nurse can utilize the nursing system (as stated in the Theory of Nursing System) that best fits the patient's ability to perform self-care. In the end, the nurse assists the patient in meeting his/her self-care needs so that he/she is healthy and free of illness.
 
LETS PICTURE IT!
 
 
 
 
Major Concepts of Nursing according to Orem
 
Nursing theories have four concepts that are central to their metapardigm: person, environment, health, and nursing. However, each nurse theorist defines these concepts differently, depending on their fit into the theory. Below is a powerpoint that outlines Orem's definitions of these 4 concepts.
 
 
 
How are the four concepts related?
The person (or patient) is the central focus of nursing care. According to Orem, the person's health state is mediated by his/her environment. A person, who is healthy, is capable of self-care. When there is illness in the person's health state, the person is not able to complete all self-care requisites. When this occurs, nursing care is needed to assist the person in completing his/her self-care. Nurses must assess the person's ability to provide his/her own self care and the environmental context of the person in order to overcome health-associated limitations.
 
 
 
Orem's Self-Care Deficit Nursing Theory as a THEORETICAL FRAMEWORK for Nursing Practice
  
  • Combining the three sub-theories and major concepts creates the general Self-Care Model, which outlines Orem’s nursing process.
  • This process determines the self-care deficits and defines the person or nurse’s roles in meeting the self-care demands
  • This nursing process has 3 steps, which is comparable to the currently used and taught nursing process
 

Nursing Process

Nursing Process we are familiar with

Orem’s Nursing Process

  • Assessment

Diagnosis and prescription. Why is nursing needed? Analyze, interpret and make judgments regarding patient care

Step 1- collecting data on:

  • Person’s health status, requirements for self care and capacity to perform self care
  • Physician’s and person’s perspective of the person’s health
  • Health goals within the context of life style, health status, and life history  
  • Nursing diagnosis
  • Plans with scientific rationale

Designing nursing system and plan for delivery of care

Step 2

  • Nurses design a system that is wholly compensatory, partly compensatory or supportive-educative
  • Goals are to promote patient’s therapeutic self-care demands and compensate or overcome patient’s self-care deficits
  • Implementation
  • Evaluation

Production and management of nursing systems

Step 3

  • Nurse assists the patient or family in self-care needs to attain goals toward positive health and health related outcomes
  • Actions are guided by rationale of nursing diagnosis
  • Evaluation of results achieved compared to planned outcomes
 
 
Assumptions and Propositions
  • Assumptions:
     
  • Nurses deliberately and purposefully perform nursing as a helping service to others
  • People are willing and capable of performing self-care for themselves and for dependent family members (children).
  • Health, well-being, and human development is dependent on self-care as a necessity in life
  • Individuals are influenced by culture and education
  • Communication and human interaction fosters and teaches self-care
  • Deliberate and systematic actions are performed to meet self-care
  • Each person possesses interests, powers, talents, values, capabilities, and personal dispositions
  • Each individual is self-reliant and responsible for his or her own care and others in his or her family needing care
  • People are separate from their environment and others

 

  • Propositions:
  • Age, experiences, developmental state, and sociocultural background influences self-care abilities
  • Capabilities to provide own self-care and care for others are learned and recalled
  • Self-care capabilities and self-care demands should be balanced by self-care deficits
  • Life experiences, health, sociocultural orientation, resources, developmental stage, and age mediates self-care or dependent care
  • Nurses, patients and others are involved in therapeutic self-care by meeting self-care needs and regulating self-care capabilities
  • Nurses assess patients' abilities and potentials in meeting and performing their self-care needs
  • Nurses select reliable and valid processes, actions, and/or technologies in meeting needs for self-care
  •  
 

Using Orem’s Theory in Practice

  • Researchers have used Orem’s theory as a basis for the development of research instruments
  • Moore (1995) developed and tested a self care questionnaire to measure the self care practice of children and adolescents
  • Orem’s theory has served as a conceptual framework in associate degree programs in many nursing schools
  • Orem’s theory can be applied to the three levels of prevention: primary, secondary, and tertiary
  • Primary – when nursing care is aimed at developmental or universal self-care and when they are therapeutic
  • Secondary or tertiary – when nursing care is aimed at health-deviation self-care
  • It has a broad scope in clinical practice but has a lesser extent in research, education and administration

  

Who developed this theoretical model and what did they use the theory to examine?
  • As stated previously at the beginning of this webpage, the theoretical model was developed by Dorothea Orem
  • Orem used her theorey to examine the self care needs of persons and nurse's role in assisting or supporting persons in meeting those needs. Orem saw that in order for a person, in ill health, become healthy and well, certain self-care needs must be met. If a person is not capable of providing any self care, the nurse would be responsible for providing most of the care. On the other hand, if the person is fully capable of providing basic self care, the nurse would be the supporter/educator/faciliator of that self care.
  • In summary, Orem's Self Care Theory examines how people or communities can achieve a healthy state through self care, by themselves or with the help of the nurse.
  •  
     
    References:
    Cardinal and Stritch University Library. (2011). Dorothea Orem 1914- Self-care Framework. Retrieved from:http://library.stritch.edu/research/subjects/health/nursingTheorists/orem.html
    Masters, K. (2011). Nursing Theories: A Framework for Professional Practice. Sudbury, MA: Jones and Bartlett Learning, LLC.
    Nursing Theories. (2011). Dorothea Orem's Self-care Theory. Retrieved from: http://currentnursing.com/nursing_theory/self_care_deficit_theory.html
    Orem, D. (1959). Guides for developing curriculum for the education of practical nurses. Washington, DC: U.S. Government Printing Office.
    Orem, D. (1990). A nursing practice theory in three parts, 1956-1989. In M. E. Parker (Ed.),  Nursing theories in practice (p. 47-60). New York: National league for Nursing.
    Sitzman, K. L. & Eichelberger, L. W. (2011). Understanding the Works of Nurse Theorists: A Creative Beginning (2nd ed.). Sudbury, MA: Jones and Barlett Learning, LLC.
      
     
    Comments